The INR and either the extent of bleeding or timing of surgical intervention should be used to determine the level of warfarin reversal.2 Table 2 provides common clinical scenarios and reversal options. Conversion to warfarin: Since dabigatran contributes to INR elevation, warfarin’s effect on the INR will be better reflected only after dabigatran has been stopped for ≥2 days. Vitamin K and prothrombin complex concentrate (PCCs) can be used for warfarin reversal. Andexanet alfa and idarucizumab are specific reversal agents for DOACs and DTIs, respectively. Reversal of warfarin with Vitamin K should be reserved only for the most serious bleeding events or patients who will not be restarted on warfarin. Vitamin K should be administered either orally or intravenously (IV) only. Oral Vitamin K is the safest and most reliable route. For warfarin-treated patients who need to undergo a semiurgent (within 24–36 hours) procedure, low-dose oral vitamin K, given the day before the intervention, will often achieve sufficient INR correction and avoid the need for transfusion. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 PDF. For the emergent reversal of anticoagulation, there is only one dose and one route of vitamin K that should be used: 10 mg of IV vitamin K infused over 30 minutes. Timely and effective pharmacologic reversal of anticoagulation remains critical for events of major bleeding, emergency surgery, and high-risk procedures. Whenever possible, anticoagulation should be resumed in a timely manner to avoid thromboembolic complications related to the underlying indication for anticoagulation. Whenever possible, antithrombotics should be resumed in a safe, timely manner through shared decision making to avoid thromboembolic complications. Clearance is reduced and half-life is prolonged in renal dysfunction.